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Nursing Facts by the Numbers

One sunny Saturday afternoon last winter, a man, a woman and their newborn were at a New York City café for brunch. During the meal, the mom brought the baby to her breast, arranged a scarf around her and began to nurse. No biggie, right? Not necessarily; the new mom was Beyoncé, who's not only one of the most recognizable women in the world, but also African-American, the demographic least likely to breastfeed, publicly or otherwise. The blogosphere erupted, and within hours, the pop star was likened to a dairy cow on one website and a trailblazer for black women on others.

What might seem like a tempest in a C-cup is actually a pretty good reflection of how divided moms are when it comes to the seemingly simple act of nourishing a baby. On one hand, breastfeeding is more in the spotlight than ever. Beyoncé, Angelina and Gwen Stefani have done it — and openly. The American Academy of Pediatrics (AAP), the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) urge all mothers to do it. Heck, the IRS is even paying people to do it, announcing tax breaks for breast pumps last year. But there are still plenty of moms — one of every four — who start their babies on formula and never look back.

“We can celebrate the fact that breastfeeding rates have been rising since 1990, but our work isn't done,” says Cria Perrine Ph.D., a CDC epidemiologist. “Seventy-five percent of women start breastfeeding in the hospital, but only 44 percent are still doing it six months later. And there are racial disparities — 74 percent of Caucasian and more than 80 percent of Hispanic and Asian moms breastfeed for at least some period of time, but just over half of black mothers do. We're obviously not giving all women the support they need.

Most Likely to Breastfeed:

Oregon

Washington

California

Least Likely to Breastfeed:

West Virginia

Mississippi

Louisiana

A Better Start

How has such a personal choice become such a public issue? First, medical experts today roundly agree that babies are best served by breast milk, and breast milk only, for their first six months of life. The AAP recommends that babies continue to drink breast milk once they start solids, until at least 12 months, and the WHO goes even further, urging moms to provide their infants breast milk along with other foods until their kids are 2. “The longer you can breastfeed, the better,” says Margreete Johnston M.D., a Tennessee pediatrician and member of the AAP's breastfeeding section. “The immune system benefits alone, particularly in the first year, are enormous.” Breastfed babies are less likely to have ear infections, gastrointestinal illnesses and pneumonia early in life, and obesity-related issues like Type 2 diabetes later. They're also more protected against sudden infant death syndrome (SIDS) — possibly because breastfeeding babies eat more frequently than formula-fed ones, making moms more aware of their sleeping rhythms, says Dr. Johnston. Breastfeeding moms benefit too: They're less likely to develop diabetes and breast and ovarian cancers, and — bonus! — tend to peel off pregnancy pounds sooner. “It's something your body is built to do, and that the vast majority of women can do,” says Perrine. That attitude has become standard in many circles, especially in the Pacific North-west and New England — “places where there tends to be a lot of breastfeeding support, such as lactation consultants and laws to protect public breastfeeding,” Perrine says.

That was truly the case for Lauren Hartman, 27, of Portland, Oregon, a state where more than 9 of 10 women says Hartman. Four months later, she was still nursing Fern — at home, at restaurants, even walking through the aisles of a grocery store. “Around here, everyone just assumes you breastfeed,” she says. “If you formula-feed, it's almost as if you're an outcast.”Booby Traps

“There are lots of ‘booby traps' that prevent women from breastfeeding,’ says Nancy Mohrbacher, a certified lactation consultant and author of Breastfeeding Made Simple. While some women don't want to nurse and a small percentage aren't able to, many women throw in the burp towel simply because they lack support. Here, we break down the most common breastfeeding pitfalls — and ways to overcome them:

1.) Lack of Info:

Women aren't getting the message that breast is best. A 2007 study by North Carolina researchers of women receiving assistance from Women, Infants and Children (WIC), the federal program supporting low-income mothers, found that just 36 percent of moms in this group even knew that breastfeeding helps protect against infant diarrhea. Not surprisingly, babies who are born into the WIC program — roughly half of all U.S. infants — are less likely to be breastfed. The fact that not all hospitals have lactation consultants available for daily rounds certainly isn't helping bridge the information gap. “Research shows that when you don't start breast-feeding in the hospital, you aren't likely to start later,” says Perrine.

What You Can Do:Learn breastfeeding basics before the hungry babe arrives. Websites like Kelly Mom contain great tips, including positions to try when starting out. Many WIC branches have lactation consultants who pay complimentary visits to new moms in the hospital — call yours to see if you're eligible. When shopping hospitals, call around to see which ones have lactation consultants visiting with new moms daily.

2.) It's Hard Work:Some women try to breastfeed and really, truly can't — this includes the 5 percent of moms who have a low milk supply, often due to glandular problems (prior breast surgery could be a factor). “For these mothers, we focus on celebrating and protecting a healthy baby because that's what counts,” says Dr. Johnston. But plenty of moms mistakenly think they can't make enough milk — when in fact their baby just needs help latching more effectively or is going through a growth spurt. Still more women quit because breastfeeding can, well, suck at times. “Some babies are born with latching problems or special needs,” says Dr. Johnston. “If they don't nurse well, it can be a vicious cycle: They take less milk, you make less milk. Nipples get sore. Babies get fussy. Sometimes it seems easier just to go ahead and wean.”

What You Can Do:

Some WIC-affiliated lactation consultants make free house calls for latching problems or pain. If you can, spring for a session with an International Board Certified Lactation Consultant — they can charge between $20 and $200 per session, but some insurance plans cover the cost. Find one at ilca.org — and put her on speed dial. 3.) And It's Hard at Work:

While breast milk may be free — saving upward of $1,200 a year in formula costs — breastfeeding isn't, especially for working women. “For some moms, breastfeeding isn't a ‘choice’ at all,” says Mohrbacher. The Family and Medical Leave Act ensures 12 weeks of job protection for new mothers in workplaces of 50 people or more, but no promise of paid leave. To support their families, many moms leave their babies with a caregiver a week or two after birth. Pumping is easier courtesy of 2010 legislation that requires companies to provide women with a clean, quiet place to breastfeed, but the law doesn't cover small workplaces or require employers to pay women during pumping breaks. That may help explain why just 15 percent of women meet the AAP ideal of exclusive breastfeeding through six months — and less than 45 percent are doing it at all by their baby's half-birthday.

What You Can Do:Talk to your boss and human resources rep about your breastfeeding plans in your second trimester. Try to negotiate as much paid leave as possible — you may want to tack on vacation days. Push for the creation of a clean, private space to pump milk, if there isn't one (the ladies' room, by law, doesn't count). If you're a wage earner, see if you can come in early or stay late at work to make up for pumping breaks.

4.) It's Completely Foreign to Me: Breastfeeding role models can be scarce. Even for those who have the time and space to breastfeed, nursing — with its promise of occasional discomfort and ill-timed nip slips — can sometimes be a tough sell. “Most mothers today were born at a time when formula feeding was the norm,” says Mohrbacher. “Women often turn to their mothers for guidance, and if there's no experience there, there may be no support.” This is often true for African-American moms, who are more likely than women of other races to use formula even when they have higher incomes and educational degrees, factors usually associated with breastfeeding. “There's a cultural bias against breastfeeding that traces back to the time when black women served as wet nurses for their masters,” says Kiddada Green, 34, founder and president of the Black Mothers Breast Feeding Association (BMBFA), which uses social media and on-site hospital visits to reach moms. “Many women still associate bottle feeding with something the elite do; if you nurse your child, you must be poor.”

What You Can Do:Make breast friends. The La Leche League (llli.org) links nursing moms through local support, and Breastfeeding USA (breastfeedingusa.org) connects women with “breastfeeding counselors,” experienced mothers who've gone through a four- to six-month training program to provide phone, e-mail or in-person support. The BMBFA has a Facebook page where moms trade tips. “Breastfeeding can be isolating,” says Mohrbacher. “But the more you surround yourself with other moms who are doing it too, the more you'll understand your experiences are normal.”

The Biggest Payoff Ever

Fewer doctor's visits and trips to the supermarket aren't the only rewards of nursing. For many moms, the sweetest memories of their baby revolve around the peace and warmth of a sleepy, skin-to-skin feeding. “Fern isn't a ‘cuddly’ baby — she prefers to explore,” says Hartman. “Breastfeeding is extra-special because it's a time when I can snuggle her close.” Likewise, it was only after she started nursing her first child that Green realized the need for the Black Women's Breast Feeding Association. The possibility of healthier moms and babies was only part of it. “I loved breastfeeding my daughter so much I ended up doing it for 15 months,” says Green. “I want to make sure that other mothers don't miss out on something so wonderful.”

Wanna Mix It upMany moms clearly find their happy place in an approach that combines breast- and formula-feeding: Nearly one-quarter — up from 16 percent in 2000 — are still feeding their babies some breast milk by their first birthdays. If you go the combo route:

Try to breastfeed exclusively for at least the first few weeks, until your milk supply is established and your baby has learned to latch effectively. Otherwise, he may become accustomed to the ease of feeding from an artificial nipple and resist nursing altogether.

If you are away from your baby for most of the day, try to fit in a pumping session. “If you don't empty your breasts at least once during a typical workday, your supply may dwindle very quickly,” says Dr. Johnston.

Take care when combining formula and breast milk, since bacteria multiply more quickly in formula. While a partially consumed bottle of expressed milk can be served to a baby at his next feeding, a mixture with any amount of unfinished formula should be tossed.